European Journal of Case Reports in Internal Medicinehttp://ejcrim.com/index.php/EJCRIM
<div id="home_page_html"><table width="100%" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td style="background-image: url('/public/journals/1/stetoBG.jpg');" valign="top" width="100"> </td><td valign="top"><p style="margin-bottom: 20px;"><span class="home_pageBLU">The European Journal of Case Reports in Internal Medicine</span> is an official journal of the European Federation of Internal Medicine (EFIM). The journal wants to promote the practice of internal medicine in Europe. Its aim is to provide a forum to internal medicine doctors.<br /> <span class="home_pageBLU">EJCRIM</span> welcomes papers describing unusual or complex cases and case series that an internist may encounter in everyday practice. Case series are also welcomed as long as they demonstrate the appropiateness of a therapeutical approach or unusual manifestation of a disease. <br /> The journal would also consider brief reasoned reports of issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to scientific meetings of European societies of Internal Medicine.</p><p>EJCRIM utilizes the <a title="CNR-SOLAR" href="http://eprints.bice.rm.cnr.it/" target="_blank">CNR-SOLAR</a> system to permanently archive the journal for purposes of preservation, reservation and research and it is also indexed on <a href="https://scholar.google.it/scholar?hl=it&amp;q=ejcrim&amp;btnG=&amp;lr=" target="_blank">Google Scholar</a> and <a href="https://doaj.org/toc/2284-2594?source=%7B%22query%22%3A%7B%22filtered%22%3A%7B%22filter%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22term%22%3A%7B%22index.issn.exact%22%3A%222284-2594%22%7D%7D%2C%7B%22term%22%3A%7B%22_type%22%3A%22article%22%7D%7D%5D%7D%7D%2C%22query%22%3A%7B%22match_all%22%3A%7B%7D%7D%7D%7D%2C%22from%22%3A0%2C%22size%22%3A100%7D" target="_blank">DOAJ</a>. We encourage the use of <a href="https://www.growkudos.com/publishers/smcmedia" target="_blank">Kudos</a> to maximize the article's visibility. </p></td></tr><tr><td valign="top" width="100"><img src="/public/journals/1/stetoEND.jpg" alt="" width="100" height="30" /></td><td valign="middle"><p><span class="home_pageBIG">EJCRIM is peer-reviewed with single-blind review and freely accessible to all.</span></p></td></tr></tbody></table></div><div style="width: 100%; height: 1px; margin-top: 20px; margin-bottom: 20px; background-color: #cccccc;"> </div>en-US<p><strong><span style="color: #6db2db;"> Copyright and Disclosures</span></strong></p><p>Every author must sign a copyright transfer agreement and disclose any financial or professional interest in any company, product, or service mentioned in an article. This authorization includes all submitted text including illustrations, tables, and other related materials.<br />If this submission contains any <strong>material that has been previously published</strong>, this authorization <strong>must also be accompanied</strong> by all necessary “Permission to Reproduce Published Material” forms completed by the current copyright owner. If this submission contains any <strong>previously unpublished material</strong> for which the person(s) signing this form <strong>does not own copyright</strong>, an additional “Authorization to Publish” form is required from each corresponding copyright owner.</p><br /><p><strong><span style="color: #6db2db;"> Copyright Transfer Declaration</span></strong></p><p>(this may be included as a word document with your manuscript submission)<br /> I confirm that I am the current copyright owner of the material described above and hereby transfer and assign to the European Journal of Case Reports in Internal Medicine (EJCRIM) all copyrights in and to the material for publication throughout the world, in all forms and media, in English and in any other language(s). Such transfer includes publication in this and all future editions of the publication named above and in any other publications (including slide collections and any other nonprint media) of EJCRIM and gives EJCRIM the sole authority to grant rights for use of the material by others.<br />I waive EJCRIM from any liabilities connected to the incorrect copyright statement.<br />The copyright agreement form can be downloaded <a style="font-weight: bold;" href="/docs/EJCRIM_Copyright_auth.pdf">HERE</a> or requested to the editorial office <a style="font-weight: bold;" href="mailto:ejcrim@smc-media.eu">ejcrim@smc-media.eu</a></p>ejcrim@smc-media.eu (Editorial Office)ejcrim@smc-media.eu (Editorial Office)Tue, 29 Aug 2017 14:03:41 +0000OJS 2.4.7.1http://blogs.law.harvard.edu/tech/rss60Senile Systemic Amyloidosis: An Underdiagnosed Diseasehttp://ejcrim.com/index.php/EJCRIM/article/view/725
<p>Senile systemic amyloidosis is caused by a non-mutated form of transthyretin with the heart being the major organ involved. This infiltrative cardiomyopathy usually presents as slowly progressive heart failure. <br /> An 82-year-old female patient was admitted for newly diagnosed heart failure. A year later she presented with decompensated heart failure and syncope. Inpatient work-up showed persistently elevated troponin and N-terminal-pro BNP levels, rapid progression to severe left ventricular concentric hypertrophy, and sinus pauses on the Holter. Cardiac MRI revealed diffuse late gadolinium enhancement in the left ventricle. The demonstration of amyloid protein with the clinical findings and complementary investigations allowed for the diagnosis of senile systemic amyloidosis.</p>Marta Catarino Manso, Diogo Paixão Marques, Sara L. Rocha, Simão C. Rodeia, Raquel Domingos
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/725Thu, 21 Sep 2017 08:43:39 +0000Neurosyphilis Presenting with Papillitishttp://ejcrim.com/index.php/EJCRIM/article/view/718
<p>Syphilis is one of the oldest described infectious diseases in the world and is caused by the spirochete bacterium <em>Treponema pallidum</em><sup>[1]</sup>. Although now a rare disease, incidence is increasing with the number of diagnoses of the disease rising in England from 1688 to 2713 between 2003 and 2012 (a 61% increase)<sup>[2]</sup>. Major outbreaks of syphilis have been documented in London, Manchester, Dublin, and Brighton particularly among men who have sex with men (MSM)<sup>[3]</sup>. Diagnosis remains difficult on account of multi-system symptoms, duration of the condition, and social stigma.</p>Martin Edward Perry, Sarah Cooper, Shona Corry
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/718Tue, 05 Sep 2017 09:22:15 +0000When Hypereosinophilia Leads to Strokehttp://ejcrim.com/index.php/EJCRIM/article/view/614
<p>AFIP1L1-PDGFRA fusion can only be confirmed through molecular and cytogenetic investigations causing a delay in the diagnosis. However, patients with this mutation need urgent treatment because they present hypereosinophilia which may be associated with short-term tissue damage. Thromboembolism is a known cause of death in hypereosinophilic syndrome. A case of Loeffler endocarditis due to FIP1L1-PDGFRA-associated chronic eosinophilic leukemia presenting hemiparesis with fever, which also mislead the initial diagnosis, is reported.</p>Emilie Chalayer, Aude Pelissier, Bernard Tardy
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/614Tue, 29 Aug 2017 14:03:41 +0000Sometimes Surgery is the Only Way to Make a Diagnosis and Treat the Patient: A Case of Congenital Partial Absence of Pericardiumhttp://ejcrim.com/index.php/EJCRIM/article/view/593
<p><em>Introduction:</em> A 47-year-old Caucasian woman with a past medical history of multiple ablative procedures for supraventricular arrhythmias and pacemaker implantation presented with increasing shortness of breath. The initial working diagnosis of the team treating her was ablation-induced pulmonary stenosis, especially after the recording of increased flow velocities through the right lower pulmonary vein. <br /> <em>Case presentation:</em> The patient was alert and oriented, but obviously dyspnoeic. The vital signs were normal. The physical examination revealed a soft cardiac systolic murmur and the lungs were clear on auscultation. The electrocardiogram showed a pacemaker rhythm. The echocardiogram showed borderline normal global systolic function of the left ventricle and severe mitral regurgitation. The transoesophageal echocardiogram confirmed the above findings and revealed increased velocities through the right lower pulmonary vein. The working diagnosis of ablation-induced pulmonary stenosis was reinforced by the cardiac CT angiography. The patient was subsequently referred for surgical intervention. The intra-operative findings were both unexpected and impressive: congenital partial absence of the pericardium was responsible for herniation of the right chambers into the pleural space. Mitral regurgitation was attributed to failure of coaptation due to the very short surface of the leaflets. Extensive external fibrosis around the pulmonary veins caused the pulmonary vein stenosis. <br /> <em>Conclusion:</em> The final diagnosis of a partial pericardial defect causing torsion and distortion of the heart chambers was made only at surgery. The consistent finding of pulmonary vein stenosis in the non-invasive modalities and the past medical history of ablations initially misleadingly led us to the assumption that they were related.</p>Phivos Costas Symeonides
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/593Tue, 29 Aug 2017 14:03:41 +0000Lemmel’s Syndrome: A Rare Cause of Obstructive Jaundice Secondary to Periampullary Diverticulumhttp://ejcrim.com/index.php/EJCRIM/article/view/632
<p>In 1934 Lemmel was the first to report the presence of juxtapapillary diverticula and hepatocholangiopancreatic disease, excluding cholelithiasis. Obstructive jaundice caused by periampullary duodenal diverticulum (PAD) in absence of choledocholithiasis or tumor is known as Lemmel syndrome. A patient with an extraluminal duodenal diverticulum presenting with obstructive jaundice and pancreatitis is presented in this case. Although initially managed conservatively, the patient had recurrence of symptoms after 2 months but then had successful surgical resection of the duodenal diverticulum.</p>Babar Ahmad Khan, Sania Hanif Khan, Anuj Vikrant Sharma
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/632Tue, 29 Aug 2017 14:03:41 +0000Recurring Lower Abdominal Pain and Fever as Initial Presentation of Adult Onset Still’s Disease in the Absence of Arthralgia and Other System Involvementhttp://ejcrim.com/index.php/EJCRIM/article/view/619
<p>A 34 year-old Afro-Caribbean female presented with recurring episodes of fever and lower abdominal pain over a period of two months not improving despite courses of antibiotics for possible recurrent urinary tract infections. On admission to hospital, patient was treated for a possible pyelonephritis or pelvic inflammatory disease (PID). Extensive investigations into possible source of infection were carried out. However, all of the repeated microbiological cultures were normal. Patient was investigated further for other possible causes including connective tissue disease, haematological disorders, or neoplasm, all of which were normal. Diagnosis of adult onset Still’s disease (AOSD) was confirmed by a rheumatologist based on Yamaguchi’s diagnostic criteria for AOSD alongside significantly raised serum ferritin. Patient was treated with steroids to which she showed remarkable clinical improvement alongside marked reduction in her serum ferritin levels.</p>Abuajela Sreh, Nithyananda Rajaiah, Mohammad Saim
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/619Tue, 29 Aug 2017 14:03:41 +0000Going Round in Circles with a Multisystemic Disease: A Unique Case of Parasitic Aortitishttp://ejcrim.com/index.php/EJCRIM/article/view/601
<p>Aortitis results from aortic inflammation, frequent causes being infections and rheumatological disorders. The authors report the case of a 33-year-old black male with recent arterial hypertension, who presented with recurrent abdominal pain, jaundice, anorexia, weight loss and diarrhoea. Laboratory work-up was compatible with inflammatory anaemia and obstructive jaundice, while abdominal imaging revealed a dilated biliary tract, no visible gallstones, cephalic pancreatic globosity and aortic thickening. Pancreatic aspirate was negative for malignant cells, bacteria and <em>Mycobacterium tuberculosis</em>. The jaundice spontaneously subsided and the pancreatic globosity improved over time. Following positive PPD and IGRA, isoniazid was started. However, follow-up investigations revealed a severe bulbar stenosis with intense eosinophilic infiltrate, multiple non-necrotizing granulomas, and thoracic and abdominal aortitis not previously recognized. Immunological profile (ECA, ANCA and IgG4), eggs and parasites in stool samples were negative. The multisystemic disease, with an insidious and migrating behaviour, gastrointestinal and vascular involvement, granulomatous inflammatory response and tissue eosinophilia, raised the suspicion of a parasitic infestation (despite negative screening) or vasculitis. After 7 days of empirical treatment with albendazole and ivermectin, the patient passed a specimen of Ascaris lumbricoides in the stool and improved clinically.</p>Maria Lobo Antunes, Gonçalo Cabral, Raquel Tavares, Carla Noronha, José Araújo
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/601Tue, 29 Aug 2017 14:03:41 +0000Chronic Mercury Intoxication Masquerading as Systemic Disease: A Case Report and Review of the Literaturehttp://ejcrim.com/index.php/EJCRIM/article/view/623
<p><em>Background:</em> Mercury is a highly toxic environmental metal that exists in three different forms: elemental, inorganic and organic. Intoxication occurs in either occupational or non-occupational settings, mainly after the inhalation of vapour and fumes in work places, laboratories or homes. Chronic mercury toxicity ranges from mild and insignificant to severe and life-threatening. We describe the case of a young male patient who presented with multiple organ dysfunction after chronic mercury exposure. <br /> <em>Case presentation:</em> We report the case of 28-year-old male artisanal gold miner who was admitted to hospital for severe neurological impairment associated with inflammatory bowel disease-like symptoms and a skin rash after mercury exposure. Symptomatic treatment and corticosteroid administration assured rapid clinical improvement. Chronic mercury poisoning can masquerade as an autoimmune or systemic inflammatory disease. <br /> <em>Conclusion:</em> Physicians should be aware that low exposure to mercury, even from artisanal gold mining, may be harmful to health. Management can be simple without the need for aggressive or invasive therapeutic measures. Larger case series are required in order to establish a clear management plan.</p>Alexandre Malek, Krystel Aouad, Rana El khoury, Maya Halabi-Tawil, Jacques Choucair
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/623Tue, 29 Aug 2017 14:03:41 +0000Acute Paraplegia with Cognitive Alterations After Bilateral Infarcts in Cerebral Small Vessel Diseasehttp://ejcrim.com/index.php/EJCRIM/article/view/697
<p>Cerebral small vessel disease (SVD) affects the small arteries, arterioles, venules and capillaries in the brain and can be identified clinically and/or radiologically. We describe the case of a 71-year-old man with sporadic cerebral SVD who presented with acute paraplegia with urinary incontinence and recent cognitive impairment that developed after the occurrence of ischaemic lesions.</p>Francisco Javier Ros Forteza
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/697Fri, 25 Aug 2017 08:18:00 +0000Interrupted Aortic Arch in an Adulthttp://ejcrim.com/index.php/EJCRIM/article/view/692
<p>Interrupted aortic arch (IAA) is a rare congenital abnormality with only a few cases reported in adults. It is defined as complete loss of continuity between the ascending and descending portions of the aorta, and is usually associated with other cardiac defects. The diagnosis in adults should be suspected in the presence of refractory hypertension, a careful physical examination being crucial to early diagnosis. Magnetic resonance angiography (MRA) techniques can accurately characterize cardiovascular anatomy, and also provide information regarding heart chamber and valve function.</p>Juliana Silva, Neusa Guiomar, Marisa Passos Silva, Daniel Caeiro, Vasco Gama
Copyright (c) 2017 European Journal of Case Reports in Internal Medicine
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http://ejcrim.com/index.php/EJCRIM/article/view/692Thu, 03 Aug 2017 12:43:02 +0000